I read with astonishment on UK national data on the risk of death for chemotherapy for non-small cell lung cancer in the Lancet Oncology today.[1] I was practicing under the assumption that chemotherapy is the lower risk option presented to patients who were not comfortable with the risk of death from surgery. Having compared the outcomes of the two modalities of treatment I was certainly surprised if not shocked...

The average 30-day mortality of "curative" chemotherapy for lung cancer in the UK in 2014 was reported at 3%, in contrast the average risk of death from surgery for lung cancer across the UK in 2013 was 2%.[2]

You may be thinking that the difference is "no big deal"? But the difference is a HUGE deal in the reference to how we think, act and the information which we present to patients. Although the absolute difference is small at 1%, the relative reduction in risk of death is 33%.

Of course there are caveats in that the patient cohorts are not comparable with patients in poorer states of health being offered chemotherapy in preference to surgery, however even for favourable subsets of patients such as stage I and PS 0 , each of the sub-groups also experienced a 3% mortality risk at 30 days with chemotherapy.[1]

Today marks a change in practice to which we can no longer present curative chemotherapy as a lower risk option compared to surgery.